| NPI | 1265433296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TN P0000000953) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TN P0000000953) |
| 103TA0700X Psychologist Adult Development & Aging (Licence: TN P0000000953) | |
| 103T00000X Psychologist | |
| Enumeration Date | 2005-08-01 |
| Last Update Date | 2008-02-04 |